This decade-by-decadge guide to menstruation covers irregular cycles, heavy bleeding, sudden pain and all the other issues that can pop up as we age.
Until Sarah turned 38, her Aunt Flo was nothing but predictable; she showed up every 27 to 29 days, accompanied only by a tinge of lower-back pain. There would be a slightly heavier flow on days 1 and 2, and no symptoms at all by Day 6. Then, one month, all hell broke loose. "Suddenly, my period was extremely heavy and clumpy," says Sarah. "I was changing a pad and a super-absorbent tampon every 10 minutes. It was like a murder scene." It wasn't just the amount of blood that threw both Sarah and her cycle for a loop; new symptoms surfaced over the next few months. "My whole midsection and vagina hurt. Plus, I had an overall sick feeling. I was in so much pain."
Though Sarah initially thought this was just her period changing with age, after about six months, when the excessive bleeding had become a regular occurrence, she made an appointment with her doctor. And it's a good thing she did. As it turned out, she had two uterine polyps, small tissue growths that are attached to the inner wall of the uterus and extend into the uterine cavity. Following two years of unpredictable flow, clotting and pain, Sarah's doctor performed an endometrial ablation and removed her polyps for testing—and her monthly visitor relented.
We'd bet there isn't a woman out there who hasn't been bugged, caught off guard or inconvenienced by her period. "Women just don't know a lot about their periods," adds Dr. Ashley Waddington, an obstetrician-gynecologist and assistant professor at Queen's University in Kingston, Ont. "We get a lot of questions from patients about what's happening and what will happen in years to come." Here's a decade-by-decade breakdown of what you need to know.
By this point, you've probably had your period for almost two decades, and, unless you've been pregnant, it likely hasn't changed much since your late teens. A typical cycle lasts between 21 and 35 days, counting from the first day of your period up to (but not including) the first day of your next period.
That cycle is made up of two phases: The follicular phase starts on the first day of your cycle and lasts until ovulation day, when the luteal phase, which begins once the ovary releases an egg, takes over. Because the luteal phase almost always lasts about 14 days, you can estimate the date of your last ovulation by counting backward from the end of your cycle. For example, if your cycle was 30 days, you likely ovulated on Day 16.
In general, menstruation lasts four to seven days. But don't worry if that number fluctuates somewhat, says Dr. Melissa Mirosh, an ob-gyn in Saskatoon. You're still in the normal range if, one month, your period arrives on Day 26 and lasts for five days, and, next month, it doesn't come until Day 31 and it lasts for seven days. But if the duration of your period or cycle varies more drastically, there could be a problem. "The concern is that, if the cycle isn't normal, it could be because of an underlying medical issue or it could affect fertility potential," says Dr. Suzanne Wong, an ob-gyn at St. Joseph's Health Centre in Toronto.
Prepare for: Pregnancy
Women who have irregular periods and are trying to conceive can have a rough go of it. "Predicting ovulation becomes harder when cycles are irregular, which makes achieving pregnancy more difficult," says Dr. Wong. Pregnancy can also affect what happens with your period postpartum. "After having a baby, when your hormones are still getting back to their usual routine, it can be quite normal to have chaotic cycles for six to 12 months," says Dr. Waddington.
Most women who breastfeed will resume menstruating six to nine months after delivery; those who don't may ovulate as early as three weeks after delivery and menstruate five weeks postpartum. "This is important to consider if you're resuming sexual activity, because you can get pregnant quite soon after delivery," says Dr. Waddington. And about that post-pregnancy period: There's no way to tell if it will be heavier or lighter than before, but many women who experienced excruciating cramps prepregnancy find that the pain has subsided, perhaps thanks to stretching of the uterus during those nine months.
"Between the late teens and the age of 40, women tend to get into a rhythm with their period; it comes in regular intervals, lasts about the same duration and has the same volume of blood, except perhaps in the years around pregnancies," says Dr. Mirosh. "But from about 40, things may get irregular."
Say hello to perimenopause, the seven- to 10-year stretch leading up to menopause. It usually kicks in at about age 45, though, in rare instances, it can start as early as 35 or not taper off until 59. "That's when the brakes come off and chaos occurs," says Dr. Jerilynn Prior, a professor of endocrinology and metabolism at The University of British Columbia and the founder and scientific director of the Centre for Menstrual Cycle and Ovulation Research in Vancouver. "Because estrogen levels are higher, it's a time of great unpredictability." Cue mood swings, heavy flow (in 25 percent of women), hot flashes and night sweats (in about 80 percent), shorter or longer cycles, skipped periods, sore breasts, low libido, insomnia, painful cramps and changes to skin, hair or weight. It's a misconception that these symptoms indicate you're in the throes of menopause; they're actually signs of perimenopause.
Prepare for: Heavy Flow
According to Dr. Prior, heavy bleeding is so common in perimenopause that it's often one of the first symptoms a woman will notice. But what's considered too heavy? "The definition of abnormal uterine bleeding is based on when a patient says there's too much blood," says Dr. Mirosh. Red flags (pardon the pun) include excessive clotting or cramping, accidents where blood soaks through to your clothing and simply feeling like your period is interfering with your life.
Heavy bleeding may be just that, or it might be a sign of another medical condition. Dr. Mirosh says one of the first signs of thyroid disease can be a change in menstrual flow. Uterine polyps or fibroids, usually benign growths that develop in or on the uterus, are other potential culprits. And, as a patient creeps toward 50, Dr. Mirosh begins to worry about endometrial cancer, which can also bring with it increased flow or clotting.
If you're like the average Canadian woman, you'll have your last period when you're 52. Whenever it happens, you won't actually know that you've been through menopause (which means the end of menstruation, when the ovaries run out of eggs and your body produces lower levels of estrogen and progesterone) until a year after the last time you menstruate. "It's a retroactive diagnosis," says Dr. Wong. "A woman who hasn't had a period in 12 months, who's been to her doctor to make sure there is no underlying cause for the missed periods (other than hormonal reasons) and whose period doesn't come back has gone through menopause."
Prepare for: Menopause
While many women find that their periods gradually taper off, some have a regular cycle right up until their last period, then never have one again, says Dr. Waddington. And though women will experience the most upheaval during perimenopause, most will also have at least some symptoms—such as vaginal dryness, hot flashes and insomnia—in menopause. But for many women, menopause can be a relief. "You no longer have to deal with the heavy flow," says Dr. Prior. "Bloating, swelling, breast tenderness and other high-estrogen symptoms come to an end."